Prescribers sign on to opiate-monitoring pledge

As of late last week, 57 Franklin County doctors, nurse practitioners and other prescribers had signed a pledge to minimize the danger of opioid painkillers. The pledge is a short list of best practices worked up by the health care subcommittee of the Opioid Education and Awareness Task Force.

Opioid painkillers are dangerous if misused, highly addictive and difficult to recover from, and often indispensable for what they are meant for: treating pain.

The list includes steps aimed at identifying drug-seekers and monitoring patients for any sign of a developing problem.

“It’s not just that we’re getting people to sign and there’s no teeth behind it. We’re hoping that people change their prescribing practices because of it,” said Dr. Ruth Potee, a Valley Medical Group general practitioner and anti-addiction advocate who co-chairs the subcommittee that came up with the pledge, with outgoing Baystate Franklin Medical Center President Chuck Gijanto. “I don’t think it’s just a piece of paper; it’s an individual saying, ‘I’m making a commitment to make myself better at this.’”

Thanks to a grant from BFMC parent Baystate Health, the pledge has money to pay Valley Medical Group’s prescription monitor to help other practices implement the program highlighted in the pledge.

Potee said this will include the technical work of spreadsheets, paperwork and making the best of the state Prescription Monitoring Program. The online database records prescriptions filled by patients, the information input by pharmacies and accessible to participating prescribers. Voluntary until Gov. Deval Patrick ordered its use in his declaration of an opioid public health emergency, Potee said the mandate hasn’t made much of a difference.

The system is slow, cumbersome, the information at least a month out of date and precise to the point that searches must be repeated with and without a middle name or middle initial, Potee said, and can eat half an hour of a busy doctor’s time per patient.

The upshot is that it’s not widely used. Potee conducts trainings for the Scope of Pain opioid prescription safety initiative, and said less than 10 percent of hands go up when she asks who uses the “PMP,” and the mandate hasn’t changed a thing.

The PMP is meant to help prescribers notice doctor-shoppers and potential drug-seekers, and to help law enforcement and medical agencies prosecute problem prescribers or “pill-mills.” The majority of the pledge aims to head off the problem before things get to that state.

Abuse of prescription opioids, and even use as prescribed, can lead to addiction. Experts put the addiction rate for long-term use of opioids — heroin or painkillers — at somewhere in the range of 20 to 30 out of 100 people, although these experts caution the rate has not been well studied.

The path from prescription pill abuse and addiction to heroin abuse and addiction is well-worn, and Potee considers the boom in opioid prescription of the mid-1990s to be responsible for the current boom in heroin addiction.

The pledge is geared toward long-term prescription, with provisions for regular visits between doctor and patient, patient-provider agreements — which can include drug screens and pill-counts — and learning to recognize symptoms of addiction and substance abuse disorder in patients.

Potee said a pledge tailored to short-term prescription by surgeons and emergency room doctors will follow.

“We’re hoping that surgeons take responsibility for the fact that they sometimes with their very well-meaning, very appropriate two-to-three-week opiate prescriptions end up getting people hooked on them, particularly teenagers,” she said. “You take wisdom teeth, you have a kid who fractures their femur, that is often a person’s first introduction to an opiate, and we want that first introduction to be very, very controlled.”

This will include limiting the number of pills prescribed and, in the case of minors, ensuring that parents control the medication.

“You shouldn’t be suffering, in pain, but nor should it be the best month of your life because you’re high all the time,” Potee said.

The health care solutions subcommittee is one of at least five, with Treatment, Intervention and Recovery; Justice and Law Enforcement; Community Corrections, Workforce and Housing, working under the umbrella of the Opioid Education and Awareness Task Force. Founded last year in reaction to a growing problem, the volunteer task force is spearheaded by a Greenfield District Court official, the Franklin County sheriff and the Northwestern District Attorney, now with a paid coordinator and the beginnings of state funding.

Coordinator Marisa Hebble said the Franklin Regional Council of Governments has hosted a webpage for the pledge. The pledge, related information and a link to an almost up-to-date list of prescribers who have signed the pledge can be found at frcog.org/safe-prescriber-pledge.